Outpatient taping in the treatment of idiopathic congenital talipes equinovarus

Abstract

The Ponseti and French taping methods have reduced the incidence of major surgery in congenital idiopathic clubfoot but incur a significant burden of care, including heel-cord tenotomy. We developed a non-operative regime to reduce treatment intensity without affecting outcome. We treated 402 primary idiopathic clubfeet in patients aged < three months who presented between September 1991 and August 2008. Their Harrold and Walker grades were 6.0% mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient taping regime over five weeks based on Ponseti manipulation, modified Jones strapping and home exercises. Feet with residual equinus (six feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent one to three additional tapings. Correction was maintained with below-knee splints, exercises and shoes. The clinical outcome at three years of age (385 feet, 95.8% follow-up) showed that taping alone corrected 357 feet (92.7%, 'good'). Late relapses or failure of taping required limited posterior release in 20 feet (5.2%, 'fair') or posteromedial release in eight feet (2.1%, 'poor'). The long-term (> 10 years) outcomes in 44 feet (23.8% follow-up) were assessed by the Laaveg-Ponseti method as excellent (23 feet, 52.3%), good (17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%). These compare favourably with published long-term results of the Ponseti or French methods. This dynamic taping regime is a simple non-operative method that delivers improved medium-term and promising long-term results.

Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot

“…Historically, treatment of idiopathic clubfoot deformity has used both non-operative methods of manipulation and splinting [1,2] and extensive soft-tissue releases [3][4][5]. Each method can achieve initial correction of the deformity but surgical procedures give variable results in the shortterm [5], moderate results in the longer term (with less invasive surgical procedures) [3], and poor long-term results in the majority of feet following extensive softtissue releases [6].…”

Impact of guidance and telemonitoring on foot flexibility due to postural congenital clubfoot in the first month of life: a longitudinal descriptive study

“…10 Após a mobilização, o pé era mantido na postura correta usando uma órtese ou bandagem. [4][5][6][7][8][9][10][11] A medida para aplicar a bandagem foi baseada na parte média da perna do recém-nascido até o arco plantar, caracterizando os pontos de fixação, sem aplicação de tração de fixação (Figura1).…”

Sonoelastographic Findings in Clubfeet

“…International Journal of General Medicine 2021:14 2772 like physical therapy, dynamic outpatient taping, and neuromuscular electrical stimulation might be useful for improving muscle balance and stretching the stiff posteromedial tissues. [52][53][54] With respect to this idea, elastographical identification of differences in elasticity of stiff ligaments, tendons and muscles can better direct the treatment measures towards correcting the problems. The ideal patient would have a unilateral clubfoot so elasticity in the stiff structures could be compared with the normal foot but taking into consideration that correction is usually achieved before walking age and muscle-tendon elasticity is probably minimally influenced by the child's activity at this age, a set of standard quantitative elasticity measurements in the general population as a reference for bilateral clubfoot involvement could be determined.…”